June 06, 2017 / by Barry Fernando MD

Recently, there has been a lot of news about the highly cohesive or form stable implant – also known as the “gummy bear” implant. Currently all the major manufacturers – Mentor, Allergan and Sientra have FDA approval for their version of this product. Each of these company’s products vary in the type of cohesive gel filling material, shape and surface texture of their implant. The basic principle is the same – creation of a filler inside the implant that is more solid than liquid (Figure 1), still maintains a natural feel and creates a naturally shaped breast. (Figure 2)

The implant keeps it shape

Figure 1. The implant maintains its shape even when cut in half

The Mentor Memory Shaped Implant

Figure 2. The shaped profile creates a “natural” look

I am one of the original investigators of the Mentor® Memory Shaped™ highly cohesive implants. We are just in the process of completing our 10 year follow-up of patients. This Mentor® implant (Figure 2) was recently approved by the FDA for general use. In the correct patient – those seeking a “natural “ enlargement, these implants create a very attractive result and achieve that goal. In other patients with a certain amount of droopiness and the correct type of breast shape, these implants can even create an “internal lift” without the additional external scars required for a mastopexy (breast lift). See the photos below to see the kind of result that can be obtained with implants only, in a patient with a moderate amount of breast ptosis (droopiness)

Before Breast Enlargement Surgery

After Breast Enlargement Surgery with Mentor Memory Shaped Implants

It is important to remember that not everyone is a candidate for these type of implants – it depends on many factors including:

  • The shape of your breast
  • The looseness and droopiness of your breast tissue and skin
  • Your desired size and appearance after surgery.

The best way to learn about these implants and to see if they are the correct product for your needs is to come in for a consultation and ask about them.

June 06, 2017 / by Barry Fernando MD

In my previous posting, I talked about the importance of appropriate training and education for any surgeon performing cosmetic surgery. Following those guidelines will dramatically improve the chances of getting a good post-operative outcome. This next section talks about what you, as a patient can also do to help this process.

Filling out the forms at a doctor’s office may not seem glamorous or even important unless you have a serious illness, but when it comes to surgery, it could make all the difference. Plastic surgery is no different than any other surgery – it involves anesthesia, surgical tools and comes with its own set of risks. Educating patients on the dangers might make the difference between a life-threatening complication and a successful surgical outcome.

Here are some common topics to address:

1) Medication and supplements – while most patients will be quick to let you know they’re taking prescription medication (we hope) for a serious condition, others might not disclose over-the-counter medication and herbal supplements. They might not realize that it could affect blood pressure, hematoma and healing.

– Supplements: Herbal and Dietary [information on possible effects during surgery]—-herbal-and-dietary

– When “Natural” Remedies Mean Danger for Cosmetic Surgery [press release on recent ASJ article]

– Disclose herbal and dietary supplements to your doctor before surgery [great article to share with patients on the ASJ study]
2) Smoking and drinking – we have made great strides in the fight against smoking and alcohol abuse. Most people know they shouldn’t smoke or drink before surgery and right after. However, they might know the severity of the actions, they might think twice.

– When undergoing plastic surgery, tell your surgeon about your smoking habit: a horrifying tale of how smoking affected one patient

– Twins’ Breasts are revealing: Smoking and drinking not only causes complications – they also age the body

– 5 Reasons alcohol and surgery don’t mix

3) Psychological concerns – wanting to have plastic surgery to improve your image and to feel better about something that always made you feel self-conscious is normal. Having plastic surgery to please others or to get out of depression is not. Talk to patients about deeper issues and get them the help they might not realize they need.

– – Does body image improve after dramatic weight loss? [Some interesting information about patient profiles]

– Seven Keys to help ensure patient satisfaction [overview of issues preventing a person from being happy with results]

– Plastic surgery’s link to psychology [interesting story to share with patients]


Additional Information:

Cosmetic surgery safety: Lifestyle factors play an important role–lifestyle-factors-play-an-important-role

Office-based surgical setting patient safety

June 01, 2017 / by Barry Fernando MD

The “hot button” topic in medicine right now is patient safety and optimizing outcomes. What is that and what does it mean? In a nutshell, it’s all about creating an environment where practicing physicians are educated about how to follow established guidelines in decision-making for patient care and also for dealing with complications when they arise. By doing this, patients will receive the best possible care.

As a founder of a software company that has created a mobile software platform (AnzuMedical) for physician education and collaboration, I am actively involved in this entire process. I have recently been appointed to the Patient Safety Committees of ASAPS ( American Society for Aesthetic Plastic Surgery) – specifically to develop a technological solution to accomplish the goal improving patient safety. It is a really exciting project.

Here are some basic principles for all patients to understand:

Proper and Appropriate Training and Education

Has your physician been appropriately educated and trained for the services that they are operating? For example, you wouldn’t want your family practitioner performing a facelift nor would you want your plastic surgeon treating your high blood pressure. Education and training includes undergraduate, medical school,residency training and specialty training.

Certification and Professional Membership

Your physician should be certified by the American Board of Medical Specialties (ABMS). This means that they have met all accepted professional requirements to practice in their specialty. Here is a link to the ABMS website:

Your physician should also be a member in good standing of the professional societies associated with their specialty. In plastic surgery, these societies are the American Society of Plastic Surgery (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS).

Continuing Education

Your physician should be constantly updating their knowledge base. . Professional societies and hospitals all demand that physicians maintain their memberships and certifications through continuing education. – attending meetings, reading etc…

My software platform, AnzuMedical, is the mobile education platform for ASAPS and their entire national and international membership. We are using mobile technology to facilitate delivery of educational material and also the ability for physicians to collaborate with each other. These all facilitate keeping “up to date” in the most efficient manner.

Next I will be talking about the patient’s responsibilities regarding the issues of safety and outcome.

The “Connected” Physician

June 01, 2017 / by Barry Fernando MD

Are people more motivated by health or beauty? Are we more concerned about skin cancer or wrinkles?

For years, your dermatologist has been telling you to use sunscreen regularly to prevent aging. But the funny thing is, if you’re like many people, you’ve opted for more expensive and less effective creams and potions.

Recently, doctors in Australia designed a study to motivate sunscreen use. The Wall Street Journal, June 3rd, describes a study in the Annals of Internal Medicine, demonstrating that people instructed to apply sunscreen every day showed 24 percent less skin aging, as measured by lines and coarseness of the skin, than those told to use the cream as they usually do. That is a number that should stop people in their tracks.

Though we have known for a long time that sunscreen might prevent skin aging, this study provides the first hard evidence. The designers of the study had a hidden agenda: through an appeal to vanity, their goal was to prevent skin cancer. Large, randomized trials have not been done before simply because they’re difficult to arrange and expensive.

All participants were given sunscreen with a sun protection factor (SPF) of 15+. Half were instructed to apply the sunscreen daily to exposed areas, reapplying after water immersion, heavy sweating or several hours spent outdoors, while half were told to use it as they normally would.

By the end of the study 77 percent of those told to use sunscreen daily were using it at least three to four days a week, compared with 33 percent of the control group.

Protect yourself • If you’re young, your sunburn may put you at risk for skin cancer decades later. Buy a broad-spectrum sunscreen, protecting against both UVA and UVB ray that has an SPF of 30 or higher to reduce the risk of early skin aging and skin cancer. Products claiming water resistance must say how long you can expect to get that protection while swimming or sweating, either 40 minutes or 80 minutes. Sunscreens can no longer be called “sunblocks” or be labeled as “waterproof” or “sweatproof.” Finally, slather sunscreen on heavily.

If you already have sun damage, consult with a board-certified plastic surgeon, like Dr. Fernando, and start using sunscreen religiously. If you don’t have damage or need a facelift yet – protect your skin until that time. If you’ve had a facelift or other procedure – prolong the youthful effects by being vigilant with consistent sunscreen use. It’s a win-win.